Socio-demographic, behavioural and health-related characteristics associated with active commuting in a regional Australian state: Evidence from the 2016 Tasmanian Population Health Survey.

ISSUE ADDRESSED: Physical activity is lower and rates of preventable common diseases are higher in regional/rural than urban Australia. Active commuting (walking/bicycling to get from one place to another) may benefit health through increased physical activity, but most evidence of its correlates come from urban studies. This study aimed to investigate associations between active commuting, socio-demographic characteristics, behaviours, total physical activity and health in a regional/rural Australian state. METHODS: This study used data from the 2016 Tasmanian Population Health Survey, a representative cross-sectional self-report survey of 6,300 adults in Tasmania, Australia. Logistic regression modelling investigated associations between socio-demographic, behavioural and health characteristics and past week active commuting frequency. RESULTS: In multivariable models, being younger, having tertiary qualifications, living in a socio-economically advantaged area, being physically active, having a healthy body mass index and good/excellent self-rated health were associated with engaging in more active commuting. Inner regional dwellers were no more likely than outer regional dwellers to actively commute after covariate adjustment. CONCLUSION: Strategies to promote active commuting in regional/rural areas might consider targeting older adults, those less educated, those living in socio-economically disadvantaged areas, those less physically active, those with poorer health and those with higher body mass index. Research could further investigate why these groups appear to be less active for commuting purposes. SO WHAT?: Increasing physical activity and active commuting may help to reduce rates of preventable common diseases in regional/remote areas.

Social-ecological predictors of physical activity patterns: A longitudinal study of women from socioeconomically disadvantaged areas.

Limited longitudinal evidence of the predictors of physical activity (PA) patterns over time exists, particularly among high-risk groups such as women living in socioeconomically disadvantaged areas. This study aimed to: 1) describe leisure-time PA (LTPA) and transport-related PA (TRPA) patterns over time; and 2) identify individual, social and physical environmental predictors of LTPA and TRPA patterns over five years. Baseline (2007-08) data were collected and analysed (2016-18) from n = 4349 women (18-46 years) from disadvantaged areas of Victoria, Australia. Three- and five-year follow-up data were collected in 2010-11 (n = 1912) and 2012 (n = 1560). LTPA and TRPA were self-reported using the International Physical Activity Questionnaire, and patterns categorised as consistently low, persistently increasing, persistently decreasing, or inconsistent. Compared to a consistently low LTPA pattern, greater family support predicted both persistent decreases (odds ratio [OR] 1.20, 95% CI 1.05-1.36) and persistent increases (OR 1.17, 95% CI 1.04-1.32) in LTPA, while access to childcare predicted inconsistent LTPA patterns (OR 1.66, 95% CI 1.03-2.65). For both LTPA and TRPA, PA enjoyment predicted persistent increases (LTPA: OR 1.05, 95% CI 1.02-1.10; TRPA: OR 1.03, 95% CI 1.00-1.07), persistent decreases (LTPA: OR 1.04, 95% CI 1.00-1.08; TRPA OR 1.04, 95% CI 0.99-1.08), and inconsistent patterns (LTPA: OR 1.04, 95% CI 1.02-1.07; TRPA: OR 1.03, 95% CI 1.01-1.06). Although directionality was inconsistent, and the magnitude of effects were small, PA enjoyment, family social support for PA and access to childcare warrant further investigation and consideration as potentially key factors impacting PA patterns among women living in socioeconomically disadvantaged areas.

Multimorbidity and health-related quality of life (HRQoL) in a nationally representative population sample: implications of count versus cluster method for defining multimorbidity on HRQoL.

BACKGROUND: No universally accepted definition of multimorbidity (MM) exists, and implications of different definitions have not been explored. This study examined the performance of the count and cluster definitions of multimorbidity on the sociodemographic profile and health-related quality of life (HRQoL) in a general population. METHODS: Data were derived from the nationally representative 2007 Australian National Survey of Mental Health and Wellbeing (n = 8841). The HRQoL scores were measured using the Assessment of Quality of Life (AQoL-4D) instrument. The simple count (2+ & 3+ conditions) and hierarchical cluster methods were used to define/identify clusters of multimorbidity. Linear regression was used to assess the associations between HRQoL and multimorbidity as defined by the different methods. RESULTS: The assessment of multimorbidity, which was defined using the count method, resulting in the prevalence of 26% (MM2+) and 10.1% (MM3+). Statistically significant clusters identified through hierarchical cluster analysis included heart or circulatory conditions (CVD)/arthritis (cluster-1, 9%) and major depressive disorder (MDD)/anxiety (cluster-2, 4%). A sensitivity analysis suggested that the stability of the clusters resulted from hierarchical clustering. The sociodemographic profiles were similar between MM2+, MM3+ and cluster-1, but were different from cluster-2. HRQoL was negatively associated with MM2+ (ß: -0.18, SE: -0.01, p < 0.001), MM3+ (ß: -0.23, SE: -0.02, p < 0.001), cluster-1 (ß: -0.10, SE: 0.01, p < 0.001) and cluster-2 (ß: -0.36, SE: 0.01, p < 0.001). CONCLUSIONS: Our findings confirm the existence of an inverse relationship between multimorbidity and HRQoL in the Australian population and indicate that the hierarchical clustering approach is validated when the outcome of interest is HRQoL from this head-to-head comparison. Moreover, a simple count fails to identify if there are specific conditions of interest that are driving poorer HRQoL. Researchers should exercise caution when selecting a definition of multimorbidity because it may significantly influence the study outcomes.

Using new technologies to improve the prevention and management of chronic conditions in populations.

Lifestyle factors are important in the development of chronic diseases, such as heart disease, respiratory disease, and diabetes, and chronic disease risk can be reduced by changes in lifestyle behaviors linked to these conditions. The use of mass media and community-wide strategies targeting these behaviors has been extensively evaluated since the 1970s. This review summarizes some examples of interventions and their use of media conducted within the old communications landscape of the 1970s and 1980s and the key lessons learned from their design, implementation, and evaluation. We then consider the potential and evidence base for using contemporary technology applications and platforms-within the new communications landscape-to improve the prevention and management of lifestyle-related chronic diseases in the future. We discuss the implications and adaptation of lessons derived from the ways in which new technologies are being used in commercial and political contexts and their relevance for public health. Finally, we consider some recent examples of applying new technologies to public health issues and consider some of the challenges in this rapidly developing field.

A shared framework for the common mental disorders and Non-Communicable Disease: key considerations for disease prevention and control.

BACKGROUND: Historically, the focus of Non Communicable Disease (NCD) prevention and control has been cardiovascular disease (CVD), type 2 diabetes mellitus (T2DM), cancer and chronic respiratory diseases. Collectively, these account for more deaths than any other NCDs. Despite recent calls to include the common mental disorders (CMDs) of depression and anxiety under the NCD umbrella, prevention and control of these CMDs remain largely separate and independent. DISCUSSION: In order to address this gap, we apply a framework recently proposed by the Centers for Disease Control with three overarching objectives: (1) to obtain better scientific information through surveillance, epidemiology, and prevention research; (2) to disseminate this information to appropriate audiences through communication and education; and (3) to translate this information into action through programs, policies, and systems. We conclude that a shared framework of this type is warranted, but also identify opportunities within each objective to advance this agenda and consider the potential benefits of this approach that may exist beyond the health care system.

Presenteeism--implications and health risks.

BACKGROUND: Presenteeism - or working while ill - is commonly seen as just an economic indicator of disease burden. Emerging evidence suggests it may best be conceptualised as a behaviour that has implications for the person and their employer, and one that can be clinically managed. OBJECTIVE: This article presents an overview of the phenomenon of presenteeism in the workforce and its clinical implications. It focuses on evidence relevant to the management of day-to-day, short term decisions on whether an individual should go into work while sick or take a day or more of work absence. This discussion is separate to the management of compensation and return to work issues. DISCUSSION: Certain patients will be at risk of presenteeism, even when absence may be clinically advisable, due to personal or job characteristics. Presenteeism behaviour has potential positive and negative consequences for the patient's own health, their job performance and tenure and their workplace, and these should be weighed up when helping patients to manage their work responsibilities.

Methods of analyzing patterns of multimorbidity using network analysis: a scoping review protocol.

OBJECTIVE: The purpose of this review is to summarize the techniques used for network analysis of multimorbidity to inform development of a standard methodology. INTRODUCTION: There is a growing trend of using network analysis to investigate relationships between chronic illnesses in people with multimorbidities. However, there is currently no recommended approach to calculating and displaying networks of chronic health conditions. This review intends to summarize the current literature to further the development of a standard methodology. INCLUSION CRITERIA: Studies will be included if they investigated the relationships between multiple chronic health conditions without referring to an index condition, using network analysis techniques. Studies using both survey and administrative data will be included. Studies including biological or genomic data sets will not be included as they are out of scope. METHODS: Databases searched will include MEDLINE, ScienceDirect, Scopus, and PsycINFO. All relevant publications will be included provided they were published before October 2020. Publications from all languages will be included where an appropriate translation in English can be obtained. Data extracted will include country of origin, type of data used, measure of association, software used, and notes on any specific points of methodological interest relevant to the review question.

Protecting the Mental Health of Small-to-Medium Enterprise Owners: A Randomized Control Trial Evaluating a Self-Administered Versus Telephone Supported Intervention.

OBJECTIVE: Small-medium enterprises (SMEs) are under-represented in occupational health research. Owner/managers face mental ill-health risks/exacerbating factors including financial stress and long working hours. This study assessed the effectiveness of a workplace mental health and wellbeing intervention specifically for SME owner/managers. METHODS: Two hundred ninety seven owner/managers of SMEs were recruited and invited to complete a baseline survey assessing their mental health and wellbeing and were then randomly allocated to one of three intervention groups: (1) self-administered, (2) self-administered plus telephone, or (3) an active control condition. After a four-month intervention period they were followed up with a second survey. RESULTS: Intention to treat analyses showed a significant decrease in psychological distress for both the active control and the telephone facilitated intervention groups, with the telephone group demonstrating a greater ratio of change. CONCLUSION: The provision of telephone support for self-administered interventions in this context appears warranted.

Meta-analysis of the effects of health promotion intervention in the workplace on depression and anxiety symptoms.

OBJECTIVES: The aim of the study was to investigate whether different types of health promotion intervention in the workplace reduce depression and anxiety symptoms. METHODS: A systematic review and meta-analysis of the literature was undertaken on workplace health promotion published during the period 1997-2007. Studies were considered eligible for inclusion if they evaluated the impact of an intervention using a valid indicator or specific measure of depression or anxiety symptoms. The standardized mean difference was calculated for each of the following three types of outcome measures: depression, anxiety, and composite mental health. RESULTS: Altogether 22 studies were found that met the inclusion criteria, with a total sample size of 3409 employees postintervention, and 17 of these studies were included in the meta-analysis, representing 20 intervention-control comparisons. The pooled results indicated small, but positive overall effects of the interventions with respect to symptoms of depression [SMD 0.28, 95% confidence interval (95% CI) 0.12-0.44] and anxiety (SMD 0.29, 95% CI 0.06-0.51), but no effect on composite mental health measures (SMD 0.05, 95% CI -0.03-0.13). The interventions that included a direct focus on mental health had a comparable effect on depression and anxiety symptoms, as did the interventions with an indirect focus on risk factors. CONCLUSIONS: When the aim is to reduce symptoms of depression and anxiety in employee populations, a broad range of health promotion interventions appear to be effective, although the effect is small.

Increasing incidence and mortality related to liver cancer in Australia: time to turn the tide.

OBJECTIVE: Assess national and jurisdictional incidence and mortality trends for primary liver cancer in Australia. METHODS: Analysis of Australian Cancer Incidence and Mortality data published in 2017 by the AIHW. Age-standardised rates (ASR) for 1982 to 2014/2015. Piecewise linear regression was used to assess temporal trends. For the purposes of comparison, data were also extracted for all cancers with greater burdens of disease (lung, colorectal, breast, prostate, pancreatic, and brain cancers and melanoma of the skin). RESULTS: Since 1982, the average annual percentage change (AAPC) for ASR incidence of liver cancer was 4.858% (95%CI 4.558-5.563). This marked a 306% increase from 1.822/100,000 persons (95%CI 1.586-2.058) in 1982 to 7.396/100,000 persons (95%CI 7.069-7.723) in 2014. AAPC for ASR mortality was 3.013% (95%CI 2.448-3.521): an increase of 184% from 2.323/100,000 persons (95%CI 2.052-2.594) in 1982 to 6.593/100,000 (95%CI 6.290-6.896) in 2015. ASR incidence and mortality were highest in the NT (12.607/100,000 persons), VIC (8.229/100,000) and NSW (7.798/100,000). In comparison to the other selected cancers, higher AAPC for both incidence and mortality of liver cancer were observed. CONCLUSION: Incidence and mortality associated with liver cancer have increased substantially in the past three decades, in contrast to the improved outcomes observed for many other cancers. Jurisdictional incidence rates reflect higher prevalence of hepatitis B and C. Implications for public health: In the context of Australian cancer prevention and care programs, liver cancer is an outlier. Strategies to mitigate risk factors and improve surveillance of liver health for at-risk groups are urgently required.

The Association Between Time Taken to Report, Lodge, and Start Wage Replacement and Return-to-Work Outcomes.

OBJECTIVE: The aim of the study was to determine if prolonged times taken to notify, file, adjudicate, and start wage replacement for workers' compensation claims are associated with poorer return-to-work (RTW) outcomes. METHODS: Using 71,607 claims lodged 2007 to 2012, logistic regression determined associations between time to claim filing, adjudication, and payment and (1) socio-demographic/economic, occupational, and injury-related factors; and (2) 52 weeks of wage replacement (WR). RESULTS: Prolonged times for all processing steps were associated with increased odds of reaching 52 weeks of WR. Prolonged times in more than one step increased the odds of a long-term claim. Being female was the only variable consistently associated with each prolonged processing time. CONCLUSIONS: The predictive ability of prolonged times in claim lodgement and processing and compensation payments demonstrate that shorter claims management and adjudication times could improve RTW outcomes.

A Systematic Review of Cost-of-Illness Studies of Multimorbidity.

OBJECTIVES: The economic burden of multimorbidity is considerable. This review analyzed the methods of cost-of-illness (COI) studies and summarized the economic outcomes of multimorbidity. METHODS: A systematic review (2000-2016) was performed, which was registered with Prospero, reported according to PRISMA, and used a quality checklist adapted for COI studies. The inclusion criteria were peer-reviewed COI studies on multimorbidity, whereas the exclusion criterion was studies focusing on an index disease. Extracted data included the definition, measure, and prevalence of multimorbidity; the number of included health conditions; the age of study population; the variables used in the COI methodology; the percentage of multimorbidity vs. total costs; and the average costs per capita. RESULTS: Among the 26 included articles, 14 defined multimorbidity as a simple count of 2 or more conditions. Methodologies used to derive the costs were markedly different. Given different healthcare systems, OOP payments of multimorbidity varied across countries. In the 17 and 12 studies with cut-offs of ≥2 and ≥3 conditions, respectively, the ratios of multimorbidity to non-multimorbidity costs ranged from 2-16 to 2-10. Among the ten studies that provided cost breakdowns, studies with and without a societal perspective attributed the largest percentage of multimorbidity costs to social care and inpatient care/medicine, respectively. CONCLUSION: Multimorbidity was associated with considerable economic burden. Synthesising the cost of multimorbidity was challenging due to multiple definitions of multimorbidity and heterogeneity in COI methods. Count method was most popular to define multimorbidity. There is consistent evidence that multimorbidity was associated with higher costs.

Guilt-proneness is associated with the use of protective behavioral strategies during episodes of alcohol use.

INTRODUCTION: Shame and guilt are closely related emotions with diverging implications for the development, and potential treatment, of substance use disorders. Accumulating research indicates that a guilt-prone affect style buffers individuals against the development of problematic alcohol use, while shame-proneness appears to offer no protective function. However, little is known about the manner in which guilt-prone individuals avoid the experience of alcohol use-related harms. The present study aimed to extend the shame, guilt, and substance use literature by examining whether these two self-conscious affect styles are differentially related to the use of protective behavioral strategies which reduce the risk of harms during drinking episodes. METHODS: Participants (N=281; female n=207) completed pen-and-paper measures of shame and guilt-proneness, level of alcohol use, and the habitual use of protective behavioral strategies during drinking episodes. Part-correlation analysis isolated shame-free guilt and guilt-free shame residuals in exploring relationships between self-conscious affect style and the use of protective behavioral strategies during drinking episodes. RESULTS: Guilt-proneness was consistently associated with the routine use of protective behavioral strategies during episodes of alcohol intake. In contrast, shame-proneness was unrelated to the use of such protective and harm avoidance strategies when drinking. CONCLUSION: Findings provide additional support for the argument that guilt and shame need to be considered separately in both research and substance use treatment settings.

The Associations of Multimorbidity With Health-Related Productivity Loss in a Large and Diverse Public Sector Setting: A Cross-Sectional Survey.

OBJECTIVE: To evaluate absenteeism, presenteeism, and total lost productive time (LPT) associated with multimorbidity. METHODS: Cross-sectional data from 3228 state-government employees from Tasmania were collected in 2013. The validated measures of absenteeism, presenteeism, and LPT were obtained from employees' self-reported data over a 28-day period. Analyses were stratified by sex. Negative binomial models were used to estimate the associations between multimorbidity and LPT. RESULTS: The average health-related total LPT was 1.2 (standard deviation [SD] = 2.4) and 1.7 (SD = 3.5) days for men and women with multimorbidity, respectively. Women (rate ratio [RR] = 2.9, 95% confidence interval [CI] 1.8 to 4.9) and men (RR = 4.4, 95%CI 3.0 to 6.2) with 4+ chronic conditions were significantly more likely to report LPT compared with those without any chronic conditions. CONCLUSION: We found multimorbidity is of concern within the workforce, with a positive association of multimorbidity and LPT observed, and significant differences in LPT between men and women reporting multimorbidity.

Estimating the Economic Benefits of Eliminating Job Strain as a Risk Factor for Depression.

OBJECTIVE: The aim of this study was to quantify the economic benefits of eliminating job strain as a risk factor for depression, using published population-attributable risk estimates of depression attributable to job strain (13.2% for men, 17.2% for women). METHODS: Cohort simulation using state-transition Markov modeling estimated costs and health outcomes for employed persons who met criteria for lifetime DSM-IV major depression. A societal perspective over 1-year and lifetime time horizons was used. RESULTS: Among employed Australians, $890 million (5.8%) of the annual societal cost of depression was attributable to job strain. Employers bore the brunt of these costs, as they arose from lost productive time and increased risk of job turnover among employees experiencing depression. CONCLUSIONS: Proven, practicable means exist to reduce job strain. The findings demonstrate likely financial benefits to employers for expanding psychosocial risk management, providing a financial incentive to complement and reinforce legal and ethical directives.

Multimorbidity and Health Care Service Utilization in the Australian Workforce: Findings From the National Health Survey.

OBJECTIVES: The aim of this study was to understand the patterns of health care service utilization in employees with multimorbidity. METHODS: Data were obtained from the 2011 to 2012 cross-sectional Australian National Health Survey. Past-month health care service utilization was collected for each chronic condition from a pre-specified list. Descriptive, logistic, and Poisson regression analyses were used. The data were weighted to produce nationally representative estimates. RESULTS: Multimorbid employees with arthritis had higher adjusted arthritis-specific general practitioner (GP) visit rates [rate ratio (RR) = 1.7, 95% confidence interval (95% CI) = 1.1 to 2.2, P < 0.001] than employees with arthritis alone. Similarly, multimorbid employees with cardiovascular disease (CVD) had higher adjusted CVD-specific specialist visit rates (RR = 1.6, 95% CI = 1.1 to 2.5, P < 0.05) and 2.5 times (95% CI = 1.5 to 4.0, P < 0.001) more CVD-specific other health professional visits than employees with CVD alone. CONCLUSIONS: Given the increasing number of employees managing work and chronic illnesses, these findings have implications for health services and employers.

Using digital interventions to improve the cardiometabolic health of populations: a meta-review of reporting quality.

OBJECTIVES: We conducted a meta-review to determine the reporting quality of user-centered digital interventions for the prevention and management of cardiometabolic conditions. MATERIALS AND METHODS: Using predetermined inclusion criteria, systematic reviews published between 2010 and 2015 were identified from 3 databases. To assess whether current evidence is sufficient to inform wider uptake and implementation of digital health programs, we assessed the quality of reporting of research findings using (1) endorsement of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, (2) a quality assessment framework (eg, Cochrane risk of bias assessment tool), and (3) 8 parameters of the Consolidated Standards of Reporting Trials of Electronic and Mobile HEalth Applications and onLine TeleHealth (CONSORT-eHEALTH) guidelines (developed in 2010). RESULTS: Of the 33 systematic reviews covering social media, Web-based programs, mobile health programs, and composite modalities, 6 reported using the recommended PRISMA guidelines. Seven did not report using a quality assessment framework. Applying the CONSORT-EHEALTH guidelines, reporting was of mild to moderate strength. DISCUSSION: To our knowledge, this is the first meta-review to provide a comprehensive analysis of the quality of reporting of research findings for a range of digital health interventions. Our findings suggest that the evidence base and quality of reporting in this rapidly developing field needs significant improvement in order to inform wider implementation and uptake. CONCLUSION: The inconsistent quality of reporting of digital health interventions for cardiometabolic outcomes may be a critical impediment to real-world implementation.

Compassion Fatigue among Healthcare, Emergency and Community Service Workers: A Systematic Review.

Compassion fatigue (CF) is stress resulting from exposure to a traumatized individual. CF has been described as the convergence of secondary traumatic stress (STS) and cumulative burnout (BO), a state of physical and mental exhaustion caused by a depleted ability to cope with one's everyday environment. Professionals regularly exposed to the traumatic experiences of the people they service, such as healthcare, emergency and community service workers, are particularly susceptible to developing CF. This can impact standards of patient care, relationships with colleagues, or lead to more serious mental health conditions such as posttraumatic stress disorder (PTSD), anxiety or depression. A systematic review of the effectiveness of interventions to reduce CF in healthcare, emergency and community service workers was conducted. Thirteen relevant studies were identified, the majority of which were conducted on nurses (n = 10). Three included studies focused on community service workers (social workers, disability sector workers), while no studies targeting emergency service workers were identified. Seven studies reported a significant difference post-intervention in BO (n = 4) or STS (n = 3). This review revealed that evidence of the effectiveness of CF interventions in at-risk health and social care professions is relatively recent. Therefore, we recommend more research to determine how best to protect vulnerable workers at work to prevent not only CF, but also the health and economic consequences related to the ensuing, and more disabling, physical and mental health outcomes.

Depression in working adults: comparing the costs and health outcomes of working when ill.

OBJECTIVE: Working through a depressive illness can improve mental health but also carries risks and costs from reduced concentration, fatigue, and poor on-the-job performance. However, evidence-based recommendations for managing work attendance decisions, which benefit individuals and employers, are lacking. Therefore, this study has compared the costs and health outcomes of short-term absenteeism versus working while ill ("presenteeism") amongst employed Australians reporting lifetime major depression. METHODS: Cohort simulation using state-transition Markov models simulated movement of a hypothetical cohort of workers, reporting lifetime major depression, between health states over one- and five-years according to probabilities derived from a quality epidemiological data source and existing clinical literature. Model outcomes were health service and employment-related costs, and quality-adjusted-life-years (QALYs), captured for absenteeism relative to presenteeism, and stratified by occupation (blue versus white-collar). RESULTS: Per employee with depression, absenteeism produced higher mean costs than presenteeism over one- and five-years ($42,573/5-years for absenteeism, $37,791/5-years for presenteeism). However, overlapping confidence intervals rendered differences non-significant. Employment-related costs (lost productive time, job turnover), and antidepressant medication and service use costs of absenteeism and presenteeism were significantly higher for white-collar workers. Health outcomes differed for absenteeism versus presenteeism amongst white-collar workers only. CONCLUSIONS: Costs and health outcomes for absenteeism and presenteeism were not significantly different; service use costs excepted. Significant variation by occupation type was identified. These findings provide the first occupation-specific cost evidence which can be used by clinicians, employees, and employers to review their management of depression-related work attendance, and may suggest encouraging employees to continue working is warranted.